There’s a significant opportunity to invest in tools that are preventative in nature.
Dyke: Traditional denial management activities are focused on worklists, driven by volume, age or value. More progressive models attack denials systematically, both at their source and driven by their cost of resolution. There’s a significant opportunity to invest in tools that are preventative in nature, focused on areas like registration quality, patient coverage and eligibility, as well as clinical areas such as medical necessity and authorizations.
In terms of cost to collect, providers should focus on accelerating patient collections earlier as well as improving the patient collection rate. Both can be improved by setting appropriate expectations and making it easy for patients to pay.
Bredemeyer: For hospitals with employed physician groups, one of the greatest margin improvement opportunities is ensuring they have experts in the physician revenue cycle – from charge capture through timely filing – and timely follow-up on correct payment and denials management.
We frequently see large, competent hospitals fail to truly embrace the uniqueness of the physician revenue cycle. Sometimes the same words in the hospital world don’t have the same meaning in the physician world, and organizations need to dig deep to help ensure each step of the revenue cycle makes sense to their physician groups.
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